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Mitchell Peterson, SPTAshley Sundstrom, SPTAkeila Thompson, SPT
Lauren Trail, SPTJason Wheeler, SPT
and Edilberto Raynes, MD, PhD (c)
Department of Physical Therapy
Pedal Your Way to New Bone
Introduction
Complete fracture
Incomplete fracture
http://www.eorthopod.com/sites/default/files/images/adult_femur_fx_anatomy04.jpg
Summary of Long Bone Fracture Biomechanics
(McKinnis, 2010)
Fracture Pattern Fracture Pattern AppearanceAppearance
Mechanism of Mechanism of InjuryInjury
Location of Soft-Location of Soft-Tissue Hinge*Tissue Hinge*
EnergyEnergy
TransverseTransverse BendingBending ConcavityConcavity LowLow
SpiralSpiral TorsionTorsion Vertical segmentVertical segment LowLow
Oblique-transverse Oblique-transverse or butterflyor butterfly
Compression + Compression + bendingbending
Concavity or side Concavity or side of butterflyof butterfly
ModMod
ObliqueOblique Compression + Compression + bending + bending + torsiontorsion
Concavity (often Concavity (often destroyed)destroyed)
ModMod
ComminutedComminuted VariableVariable DestroyedDestroyed HighHigh
Metaphyseal Metaphyseal compressioncompression
CompressionCompression VariableVariable VariableVariable
Epidemiology of Femoral Shaft Fracture (citation)
• 3x more common between the ages of 25-65• 1 per 10,000 people• Average of 107 days of inability to participate
in daily activities
Physiology of Bone (Peer, 2004)
• Bone is made up of:– Type 1 collagen– Proteins–Water– Osteoblasts– Osteoclasts– Osteocytes – Calcium– Hydroxyapatite
Mechanism of Bone Healing(cite)
• Bone is constantly turning over and responding to various factors.– Stress/Strain– Other osteogenic factors
Stages of Bone Healing(citation)
Stage 1 First 72 hours Hematoma formation
Stage 2 3 days to 2 weeks Osteoblasts and fibroblasts migrate to the fracture site
Stage 3 2 weeks to 6 weeks Maturation of the granulation tissue
Stage 4 3 weeks to 6 months Reunion and ossification of the fracture site
Stage 5 6 weeks to 1 year Consolidation and remodeling
Research Gap• The effect of cycling in relation to bone has
been explored and examined. However, there has been no evidence-based studies that correlate resistive cycling as an intervention with transverse femoral fracture healing rates.
Research Question
• Does resistive cycling increase the rate of healing in a complete transverse femoral fracture?
Cycling as an Intervention(cite)
• Cycling is currently incorporated in the acute phase of fracture healing.– The goal of rehabilitation should be to implement
weight bearing as soon as possible.– Full weight bearing is permitted once the bone
has fully healed.– 30-45 minutes of pain free cycling on a flat surface
is recommended.
Results
Authors Title LOE Date Results
Wilks,Gilliver, and Rittweger
Forearm and Tibial Bone Measures of Distance- and Sprint- Trained
2 2009 Comparison of bone mineral density (BMD) in male sprint-trained cyclists between the ages of 30-82 was greater compared to controls that did not participate in physical fitness activities
Warner, Shaw, and Dalsky
Bone Mineral Density of Competitive Male Mountain and Road Cyclists
2 2002 Mountain cyclists had significantly greater BMD than road cyclists and controls due to more ground-induced loads
Barry And Kohrt BMD Decreases Over the Course of A Year in Competitive Male Cylists
1 2008 Barry and Kohrt found that BMD significantly decreased in the femur in road cycling over the course of one year
Compared the results of BMD of cycling with the results of various sports from power combat lifting to ballet and swimming and controls, showing that increased rate of strain and intensity magnify BMD.
Conclusion
• Based on our findings, we conclude that resistive cycling does increase the healing rate of transverse femoral fractures.
Considerations for Future Research Peer (cite other sources)
• Obesity increases the incidence of complications post fracture
• Femoral fractures fixated with intramedullary nails allow the patient to attend physical therapy earlier
• In order to achieve the benefits of osteoprotective exercise, professionals suggest weight bearing, physical activity 3-5x/week.
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